Insurance Rate Review

Update on Insurance Rate Review for Vermont Health Connect (Health Benefit Exchange)

Green Mountain Guide to Health Insurance Rate Review

The Rate Review Process

Prior to January 1, 2012, the Department of Banking, Insurance, Securities and Health Care Administration (now the Department of Financial Regulation, hereafter “the Department”) was responsible for reviewing all health insurers’ rate requests. In its 2012 session the legislature changed the rate review process; now, the Department reviews each request and the commissioner of the Department makes a recommendation to the Green Mountain Care Board, which then decides whether to approve, disapprove or modify the requested rate. See 8 V.S.A. § 4062, 18 V.S.A. § 9375(b)(6). To meet its statutory obligation, the Board has adopted an administrative rule which sets forth the process by which health insurance rate requests will be reviewed.Rule 2.000

At its March 13, 2013 meeting, the Board voted and approved the Confidentiality Acknowledgement and Confidentiality Order regarding the treatment of confidential information in the Rate Review proceedings before the Board.

The Board's Role

Under current Vermont law, when the Board receives a recommendation from the commissioner, it begins a “contested case” review process under Vermont’s Administrative Procedure Act. See 3 V.S.A. § 801(b)(2). The Board will set a hearing date, post the date on its website, and notify the parties. If the parties waive their right to a hearing, a decision on the request will be made based on the insurer’s application for a rate change, the commissioner’s recommendation, and other written materials submitted to the Board. The Board has 30 days from receipt of the commissioner’s recommendation to approve, disapprove or modify a rate request. 8 V.S.A. § 4062(a)(1), 18 V.S.A. § 9375(b)(6).

Public Participation

The public may comment on specific rate requests which exceed 5% for 21 days from the date the Department posts the rate request to its website at http://www.bishca.state.vt.us/insurance/rates-forms/health-insurance-rate-review-data. The Department will forward the comments to the Board, which will accept additional written comments from the expiration of the 21-day period up until 48 hours prior to the scheduled hearing date.

There are two ways to comment on specific rate requests. You may send written comment to Judith Henkin, Health Policy Director, Green Mountain Care Board, 89 Main Street, Montpelier, Vermont 05620.

Or, you may submit your comment by email. Under "Pending Requests" on this webpage, click on the company name, and then click on the docket number about which you would like to comment.

For general rate review comments, please use the Public Comment form. All public comments received by the Green Mountain Care Board are “public records” under Vermont law. Absent a specific exemption, any member of the public may access public records by submitting a public records request. The Board will post public comment to rate review filings on its website, unless, in its discretion, it finds the comment inappropriate or that the comment contains confidential information, which may be redacted. Please contact the Board’s general counsel Mike Donofrio at michael.donofrio@state.vt.us if you have any questions

For rate increases of 5% or less, the Board will accept written comments from the public on its website from the date it posts the rate request to its website up until 48 hours prior to the scheduled hearing date.

Additionally, at least twice a year, the Board will hold open, public forums exclusive to the topic of insurance rates.

Business Forum, November 2012.